A. Golan

Conservative management of interstitial pregnancy using operative laparoscopy

Interstitial pregnancy has been treated so far mainly by either resection of the cornu or hysterectomy. In this article, two patients with cornual pregnancy were operated upon laparoscopically with an uneventful postoperative recovery. This laparoscopic treatment is simple, does not require extensive operative laparoscopic expertise, and is relatively short and less expensive than laparotomy.We suggest that laparoscopic conservative repair be used to replace cornual resection by laparotomy or hysterectomy in cases of early diagnosed interstitial pregnancy.

Methotrexate local injection for unruptured tubal pregnancy: an alternative to laparotomy?

Fifty‐nine women with early unruptured tubal pregnancy were treated by a single local injection of methotrexate at laparoscopy. All 59 patients underwent the procedure without any adverse reaction, 47 (80%) of them needing no laparotomy. Twelve patients required a laparotomy for reasons such as rising β‐hCG levels and abdominal pain with or without rising levels of β‐hCG. Only one patient ruptured the tube. None of the women needed a blood transfusion. We found tubal patency in 19 out of 21 patients at follow up hysterosalp‐ingography. Eleven pregnancies were subsequently reported, one of them tubal. The appearance of the injected tube was absolutely normal in three patients, one at cesarean section and two at repeated laparoscopy. No peritubal adhesions were observed. We suggest that this new technique is a safe and effective alternative to laparotomy in a patient with an early unruptured tubal pregnancy.

Improved Pregnancy Rate in Ivf/Et by Combined Long-Acting GnRH Analogue and Gonadotropins

The cancellation rate in In Vitro Fertilization — Embryo Transfer (IVF-Et) programmes of 20–30% [1, 2, 3] has brought us to use a GnRH analogue regimen prior to hMG administration. In order to achieve a satisfactory suppression of the endogenous activity of the hypothalamic-pituitary-ovarian axis, with the convenience of a single injection, we have chosen to use a long acting GnRH analogue preparation. We present here our experience in 143 consecutive treated cycles.

Colposuspension for urinary stress incontinence in postmenopausal patients

Eighty-seven postmenopausal patients had a colposuspension for urinary stress incontinence. A significant postoperative reduction (p<0.001) of symptoms of frequency, nocturia, urgency and urge incontinence was obtained. The cure rate for urinary incontinence was 77%. Twenty patients were found to be wet postoperatively, 8 due to stress incontinence and 12 due to detrusor instability, 9 of whom had detrusor instability preoperatively.No differences were found pre- and postoperatively in the cystometric and uroflowmetric values or in the urethral pressure profile measurements. The pressure transmission ratios were significantly improved postoperatively.During operation and postoperatively, minor complications occurred in this group of patients. In 5 patients blood transfusion was needed. Urinary tract infection was diagnosed in 21 patients, wound infections in 4 patients and enterocele in 5 patients.Colposuspension for urinary stress incontinence in postmenopausal patients is a safe procedure with a reasonable cure rate indicating that a surgical approach should be adopted in such patients.

Ultrashort gonadotropin‐releasing hormone agonist (GnRH‐a) protocol in comparison with the long‐acting GnRH‐a protocol and menotropin alone

OBJECTIVE To compare the in vitro fertilization and embryo transfer (IVF-ET) outcome of a 3-day gonadotropin-releasing hormone agonist (GnRH-a) administration: ultrashort protocol with the outcome of long-acting GnRH-a cycles or human menopausal gonadotropin (hMG) alone. DESIGN Ninety-two cycles of the ultrashort protocol were matched with 92 cycles with long GnRH-a and with 92 hMG cycles. SETTING The IVF-ET program. MAIN OUTCOME MEASURES Amount and duration of hMG treatment, hormonal profile on the day of human chorionic gonadotropin administration, cancellation rate, number of oocytes retrieved, and fertilization and pregnancy rates (PRs) were examined and compared among the three groups. RESULTS The ultrashort group needed a higher number of hMG ampules than the hMG group but significantly less than in the long GnRH-a regimen. The number of oocytes in the ultrashort protocol was the same as in the long GnRH-a, but the number of embryos per retrieval was significantly lower than with the long GnRH-a protocol and similar to that found in the hMG group. The ultrashort protocol yielded 10% PR per cycle and 17% per replacement, significantly lower than with the long GnRH-a protocol, 26% and 36%, respectively, but also lower than in the hMG one, namely 13% and 28%. CONCLUSION The ultrashort protocol, although being convenient and having some advantages found in the long GnRH-a protocol, is inferior in its outcome compared with the two other protocols.

Prediction of in vitro fertilization outcome by sperm penetration assay with TEST-yolk buffer preincubation

Distlnetion between true acrosome reaction and degenerative acrosome loss by a one-step staining method using Pisum sativum agglutinin Mendoza C; Carreras A; Moos J; Tesarik J American Hospital of Paris, 63 Boulevard Victor Hugo, F-92202 Neuilly sur Seine, FRA J REPROD FERTIL 1992 9513 (755-763) When western blots of human sperm proteins solubilized by acid extraction (presumably mainly acrosomal proteins) or by sodium dodecyl sulfate (SDS) were probed with biotinconjugated Pisum sativum agglutinin (PSA), distinct sets of proteins were labeled in both preparations. When smears of human spermatozoa were treated with methanol either for 30 s or for 15 min and then exposed to FITC-conjugated PSA, the resulting fluorescence pattern essentially depended on the time of methanol treatment. With the longer treatment, fewer spermatozoa showed selective acrosomal labeling and more were labeled uniformly throughout. without a clear predilection for a single sperm region. With the shorter time of methanol treatment, the poorly topographically differentiated, whole-cell labeling was typical of dead spermatozoa as confirmed by a close correlation between the percentages of spermatozoa showing this type of labeling and of those stained supravitally with Hoechst 33258. The preferential whole-cell labeling of dead spermatozoa with PSA is considered to be due to increased availability of the nonacrosomal set of PSA-reactive sites in dead spermatozoa after a short treatment with methanol, whereas this treatment is probably not sufficient to expose most of these sites when applied to living spermatozoa. The simplicity of the staining protocol makes this method feasible in routine work in a number of clinical and research applications.

The absence and effect of induced menopause by gonadotropin-releasing hormone analogs on lower urinary tract symptoms and urodynamic parameters

The clinical and urodynamic relationship between the onset of menopause and the appearance of lower urinary tract symptoms has been studied in 12 premenopausal urinary symptom-free patients in whom hypoestrogenism was induced by treatment with gonadotropin-releasing hormone analogs. No urodynamic changes in the cystometric, uroflowmetry, and urethral pressure profile measurements were found after 6 months of treatment. Clinically, only one patient had diurnal frequency after treatment. We conclude that estrogen deficiency in the absence of aging and other factors leading to urinary symptoms is probably of minimal significance as a cause of lower urinary tract disability in the immediate menopausal period.

Gonadotropins and combined gonadotropin-releasing hormone agonist-gonadotropins protocols in a randomized prospective study

Gonadotropins and combined gonadotropin-releasing hormone agooist-gonadotropios protocols in a randomized prospective study Ron-El R; Herman A; Golan A; Nachum H; Soffer Y; Caspi E Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin 70300, ISR FERTIL STERIL 1991, 5513 (574-578) A prospective study was designed to compare cycles stimulated by human menopausal gonadotropin (hMG) (group A) with cycles pretreated with gonadotropin-releasing hormone agonist causing pituitary desensitization followed by hMG stimulation (group B). Three hundred two cycles were randomly allocated to each group. Cancellation rate was 27.2% in group A compared with only 3.3% in group B. Significantly less hMG ampules for a shorter period were needed in group A patients. Lower estradiol and higher luteinizing hormone levels were detected in the hMG group. Patients in group B yielded significantly more oocytes and more embryos per retrieval. A significantly higher pregnancy rate per cycle was obtained in group B (27%) as compared with that of group A (13%). Moderate and severe ovarian hyperstimulation syndrome was significantly more frequent in group B than in group A.

Colposuspension for urinary stress incontinence in premenopausal and postmenopausal women

Sixty-nine premenopausal and 53 postmenopausal women had a colposuspension operation for urinary stress incontinence. A significant postoperative reduction (p less than 0.001) of symptoms of frequency, nocturia, urgency and urge incontinence was obtained in both groups. Postoperatively, 88.4 per cent of the premenopausal women were found to be dry compared with 66 per cent in the postmenopausal group (p less than 0.01). No differences were found preoperatively and postoperatively in the cystometric values or in the urethral pressure profiles at rest in both groups and between the groups. The pressure transmission ratios were significantly improved postoperatively in both groups. The postoperative transmission ratios in the premenopausal women were found to be significantly higher than those in the postmenopausal group, at the middle two-quarters of the urethra. Although surgical treatment for urinary stress incontinence in postmenopausal women results in lower cure rates than in younger women, it should be considered.